U.S. women have a 1 in 72 chance of developing ovarian cancer, according to the American Cancer Society.
Learn the most common risk factors and how to reduce your risk for ovarian from a UVA specialist in gynecologic cancer.
Selected Podcast
Reducing Your Risk for Ovarian Cancer
Featured Speaker:
Dr. Susan Modesitt
Dr. Susan Modesitt is a board-certified gynecologic oncologist who serves as director of UVA’s Gynecologic Oncology Division and co-director of UVA’s High Risk Breast and Ovarian Cancer Clinic. Transcription:
Reducing Your Risk for Ovarian Cancer
Melanie Cole (Host): US women have a 1 in 72 chance of developing ovarian cancer. My guest is Dr. Susan Modesitt. She’s a board-certified gynecological oncologist who serves as director of UVA’s Gynecologic Oncology Division and co-director of UVA’s High-Risk Breast and Ovarian Cancer Clinic. Welcome to the show, Dr. Modesitt.
Please tell us, what are the most common risk factors for ovarian cancer?
Dr. Susan Modesitt (Guest): Most women with ovarian cancer don’t have a family history of breast or ovarian cancer, but that would be one of the strongest risk factors for developing ovarian cancer. Most of the other risk factors are not something you can modify, but it’s never having been pregnant, having infertility, having endometriosis, being older aged—most women with ovarian cancer are in their 60s or 70s. And again, those aren’t modifiable.
Some things that reduce your risk of ovarian cancer are having been pregnant, taking birth control pills for at least five years in the past; having your tubes tied; or even having a hysterectomy; and obviously, having your ovaries removed. We don’t recommend that for most women.
Melanie: So if women want to reduce their risk factors but they’ve already passed the time when they might have gotten pregnant earlier, taken birth control, any of these things, are there some things that they can do?
Dr. Modesitt: Again, being aware of their risk factors. If they’re past the age where we would recommend doing birth control pills for risk reduction—and we wouldn’t recommend surgery unless they were very, very high risk—there’s not a lot more to do besides the things that we recommend for reducing your cancer risk overall, which are maintaining a healthy weight and exercising. Those are two key factors in a lot of cancer—not as much ovarian as some of the other ones. But those are the things that people can do.
Melanie: Dr. Modesitt, ovarian cancer has been called silent cancer. You know that people have heard that there are no signs and symptoms until it’s progressed a bit. Tell us about the symptoms of ovarian cancer, and what red flags might stand up that would send us to see you?
Dr. Modesitt: So the hard part about ovarian cancer is, unlike some of the other women’s cancers, like breast cancer or cervical cancer, where we have good screening, ovarian cancer doesn’t have any screening—and we’ll talk about that in a minute. But the symptoms are very vague and very subtle, and women mistake them for other things—that they’re just going through menopause, they’re getting older—and kind of let it go to the back burner. So the hallmark symptoms are feeling full—when you start to eat, you feel full very quickly—feeling bloated, and having abdominal pelvic discomfort. And the hard part is, again, these are pretty common symptoms. And if you think about, for example, pregnancy, which a lot of women go through pregnancy, it takes a long time before a mass gets big enough for it to really impair things. And so, women often don’t know that they have a mass on their ovary or their fallopian tubes until it becomes really obvious. Again, the hallmarks are bloating, feeling full, and abdominal discomfort. That happens more times in a month than not—for example, having it at least 12 times during the month. If it just happens once in a while, once in a month, once every other month, that’s not something we worry about. But if it’s a persistent thing, they should come and talk to their doctor.
Melanie: As you say, these are common situations for women. We feel bloated sometimes all the time, you know, discomfort. These kinds of things are so common for women, whether you’re younger or older, 12 times a month or all the time. Because that’s the confusing thing, Dr. Modesitt, is that women don’t know when they’re being too alarmist, when do you really go see your gynecologist and say, “I’d like to get checked for ovarian cancer.”
Dr. Modesitt: I would err on the side of caution. If it’s something that is persistent—again, not just happening once a month—I would go and talk to your doctor about it. The things we can do, again, I mentioned earlier, that there is no good ovarian cancer screening method. But if you’re having symptoms, there are very good methods to evaluate that. For example, an ultrasound can look at your ovaries and your fallopian tubes and also look into the abdomen. CT scans can be used—again, only for symptoms, not for screening—and there are some blood tests that can give us a clue that there might be a problem. But again, this is to evaluate symptom.
Melanie: So there are no screening tests, and you can evaluate symptoms. And then what happens, Dr. Modesitt?
Dr. Modesitt: Right. Well, let me talk just a little bit about screening for a second. Because there’s a lot of information in the [lay press] that you should go in and you should ask your doctor for some of these test—for example, an ultrasound to look at your ovaries, or a blood test called a CA 125 to screen for ovarian cancer. And the hard part is these tests are normal, often, in early-stage ovarian cancer, and they can be abnormal in benign conditions, like endometriosis or fibroid or things like that, that aren’t cancer. Again, they’re good to evaluate symptoms, but they don’t pick up a cancer early, which is what we would want for a screening to have. We’re actually doing a lot of research on some other novel things like short RNA fragments, and micro RNAs to try to find another way to screen women for ovarian cancer. But as of right now, there’s not any screening for normal-risk women.
Melanie: So then, what? If you do get in to your doctor and you have been diagnosed with ovarian cancer, what treatment options are available at UVA?
Dr. Modesitt: Treatment options have improved a lot. There’ve been several breakthroughs. We’re still not where we wanted to be, which is why we have a lot of clinical trials to continue to evaluate better treatments. But of some of the new breakthroughs have been using intraperitoneal chemotherapy. So the first step is usually—not always—but usually, surgery, where we remove all of the tumor that we can that is visible. And then sometimes, you can give the chemotherapy right into the abdomen. Ovarian cancer spreads on the surfaces of the organs in the abdomen, so giving the chemotherapy right into the abdomen has been shown to vastly improve survival for women. And so that’s been a breakthrough. Looking at some of the more targeted therapies is something that we’re looking at and have included some in clinical trials. Again, having an advanced surgical procedure, either before chemo or after chemo, improves survival. So those are the key things about treatment for ovarian cancer.
Melanie: Does a complete hysterectomy eliminate your risk then of ovarian cancer?
Dr. Modesitt: So hysterectomy is removal of the uterus. A salpingo-oophorectomy -- we like to make things hard to name so that only doctors know what we’re talking about.
Melanie: Absolutely.
Dr. Modesitt: But removal of the uterus is a hysterectomy. Removal of the tubes and the ovaries is a salpingo-oophorectomy. So to really reduce your risk of ovarian cancer to as low as it can go, you need to have the tubes and the ovaries removed. There’s a bit of a theory now that much of ovarian cancer actually starts with small cells that are abnormal in the fallopian tube that then gets spread into the abdomen as tiny little cells but then all grow up together. That is part of the reason we think the screening that we have doesn’t work. It doesn’t start as a small area that gets bigger and bigger and then spread. It starts as small areas that spread and then all get bigger. It’s just really tough to see it right now, to find early.
One thing we haven’t talked about that I do want to mention is I talked about family history a little bit earlier. For women that are considered very high risk—and these are women that have a family history of breast cancer, ovarian cancer, or carry one of the genes, the BRCA mutations that put those women at almost a 40 percent risk of ovarian cancer and 85 percent risk of breast cancer—women with that situation, we actually do things much more aggressively than we do in women without those risk factors. These women, we follow very closely. We do some screening and we do recommend that they have surgery to remove their tubes and their ovaries once they have completed childbearing—again, because we know the screening doesn’t work very well and they’re just at such high risk. Instead of a 1 percent risk, they’re at a 40 percent risk for ovarian cancer, so we don’t want to take that chance. And so we do risk-reducing surgery.
Melanie: So if women have the BRCA gene, it puts them at a higher risk, and then it’s just a much more aggressive approach to prevention. Please tell us, Dr. Modesitt, why should women come to UVA for their ovarian cancer care?
Dr. Modesitt: Well, there’s been a lot of studies showing that you need to go to someone that’s an expert—so what’s called a high-volume center for surgery—for the option of getting clinical trials or intraperitoneal chemotherapy. These are things that we do every day. And so the benefit of coming to UVA is you see women or men positions who are top doctors for cancer and have access to all of the newest options.
Melanie: That’s really great information. Thank you so much, Dr. Susan Modesitt. You’re listening to UVA Health Systems Radio. For more information, you can go to uvahealth.com. This is Melanie Cole. Thanks so much for listening.
Reducing Your Risk for Ovarian Cancer
Melanie Cole (Host): US women have a 1 in 72 chance of developing ovarian cancer. My guest is Dr. Susan Modesitt. She’s a board-certified gynecological oncologist who serves as director of UVA’s Gynecologic Oncology Division and co-director of UVA’s High-Risk Breast and Ovarian Cancer Clinic. Welcome to the show, Dr. Modesitt.
Please tell us, what are the most common risk factors for ovarian cancer?
Dr. Susan Modesitt (Guest): Most women with ovarian cancer don’t have a family history of breast or ovarian cancer, but that would be one of the strongest risk factors for developing ovarian cancer. Most of the other risk factors are not something you can modify, but it’s never having been pregnant, having infertility, having endometriosis, being older aged—most women with ovarian cancer are in their 60s or 70s. And again, those aren’t modifiable.
Some things that reduce your risk of ovarian cancer are having been pregnant, taking birth control pills for at least five years in the past; having your tubes tied; or even having a hysterectomy; and obviously, having your ovaries removed. We don’t recommend that for most women.
Melanie: So if women want to reduce their risk factors but they’ve already passed the time when they might have gotten pregnant earlier, taken birth control, any of these things, are there some things that they can do?
Dr. Modesitt: Again, being aware of their risk factors. If they’re past the age where we would recommend doing birth control pills for risk reduction—and we wouldn’t recommend surgery unless they were very, very high risk—there’s not a lot more to do besides the things that we recommend for reducing your cancer risk overall, which are maintaining a healthy weight and exercising. Those are two key factors in a lot of cancer—not as much ovarian as some of the other ones. But those are the things that people can do.
Melanie: Dr. Modesitt, ovarian cancer has been called silent cancer. You know that people have heard that there are no signs and symptoms until it’s progressed a bit. Tell us about the symptoms of ovarian cancer, and what red flags might stand up that would send us to see you?
Dr. Modesitt: So the hard part about ovarian cancer is, unlike some of the other women’s cancers, like breast cancer or cervical cancer, where we have good screening, ovarian cancer doesn’t have any screening—and we’ll talk about that in a minute. But the symptoms are very vague and very subtle, and women mistake them for other things—that they’re just going through menopause, they’re getting older—and kind of let it go to the back burner. So the hallmark symptoms are feeling full—when you start to eat, you feel full very quickly—feeling bloated, and having abdominal pelvic discomfort. And the hard part is, again, these are pretty common symptoms. And if you think about, for example, pregnancy, which a lot of women go through pregnancy, it takes a long time before a mass gets big enough for it to really impair things. And so, women often don’t know that they have a mass on their ovary or their fallopian tubes until it becomes really obvious. Again, the hallmarks are bloating, feeling full, and abdominal discomfort. That happens more times in a month than not—for example, having it at least 12 times during the month. If it just happens once in a while, once in a month, once every other month, that’s not something we worry about. But if it’s a persistent thing, they should come and talk to their doctor.
Melanie: As you say, these are common situations for women. We feel bloated sometimes all the time, you know, discomfort. These kinds of things are so common for women, whether you’re younger or older, 12 times a month or all the time. Because that’s the confusing thing, Dr. Modesitt, is that women don’t know when they’re being too alarmist, when do you really go see your gynecologist and say, “I’d like to get checked for ovarian cancer.”
Dr. Modesitt: I would err on the side of caution. If it’s something that is persistent—again, not just happening once a month—I would go and talk to your doctor about it. The things we can do, again, I mentioned earlier, that there is no good ovarian cancer screening method. But if you’re having symptoms, there are very good methods to evaluate that. For example, an ultrasound can look at your ovaries and your fallopian tubes and also look into the abdomen. CT scans can be used—again, only for symptoms, not for screening—and there are some blood tests that can give us a clue that there might be a problem. But again, this is to evaluate symptom.
Melanie: So there are no screening tests, and you can evaluate symptoms. And then what happens, Dr. Modesitt?
Dr. Modesitt: Right. Well, let me talk just a little bit about screening for a second. Because there’s a lot of information in the [lay press] that you should go in and you should ask your doctor for some of these test—for example, an ultrasound to look at your ovaries, or a blood test called a CA 125 to screen for ovarian cancer. And the hard part is these tests are normal, often, in early-stage ovarian cancer, and they can be abnormal in benign conditions, like endometriosis or fibroid or things like that, that aren’t cancer. Again, they’re good to evaluate symptoms, but they don’t pick up a cancer early, which is what we would want for a screening to have. We’re actually doing a lot of research on some other novel things like short RNA fragments, and micro RNAs to try to find another way to screen women for ovarian cancer. But as of right now, there’s not any screening for normal-risk women.
Melanie: So then, what? If you do get in to your doctor and you have been diagnosed with ovarian cancer, what treatment options are available at UVA?
Dr. Modesitt: Treatment options have improved a lot. There’ve been several breakthroughs. We’re still not where we wanted to be, which is why we have a lot of clinical trials to continue to evaluate better treatments. But of some of the new breakthroughs have been using intraperitoneal chemotherapy. So the first step is usually—not always—but usually, surgery, where we remove all of the tumor that we can that is visible. And then sometimes, you can give the chemotherapy right into the abdomen. Ovarian cancer spreads on the surfaces of the organs in the abdomen, so giving the chemotherapy right into the abdomen has been shown to vastly improve survival for women. And so that’s been a breakthrough. Looking at some of the more targeted therapies is something that we’re looking at and have included some in clinical trials. Again, having an advanced surgical procedure, either before chemo or after chemo, improves survival. So those are the key things about treatment for ovarian cancer.
Melanie: Does a complete hysterectomy eliminate your risk then of ovarian cancer?
Dr. Modesitt: So hysterectomy is removal of the uterus. A salpingo-oophorectomy -- we like to make things hard to name so that only doctors know what we’re talking about.
Melanie: Absolutely.
Dr. Modesitt: But removal of the uterus is a hysterectomy. Removal of the tubes and the ovaries is a salpingo-oophorectomy. So to really reduce your risk of ovarian cancer to as low as it can go, you need to have the tubes and the ovaries removed. There’s a bit of a theory now that much of ovarian cancer actually starts with small cells that are abnormal in the fallopian tube that then gets spread into the abdomen as tiny little cells but then all grow up together. That is part of the reason we think the screening that we have doesn’t work. It doesn’t start as a small area that gets bigger and bigger and then spread. It starts as small areas that spread and then all get bigger. It’s just really tough to see it right now, to find early.
One thing we haven’t talked about that I do want to mention is I talked about family history a little bit earlier. For women that are considered very high risk—and these are women that have a family history of breast cancer, ovarian cancer, or carry one of the genes, the BRCA mutations that put those women at almost a 40 percent risk of ovarian cancer and 85 percent risk of breast cancer—women with that situation, we actually do things much more aggressively than we do in women without those risk factors. These women, we follow very closely. We do some screening and we do recommend that they have surgery to remove their tubes and their ovaries once they have completed childbearing—again, because we know the screening doesn’t work very well and they’re just at such high risk. Instead of a 1 percent risk, they’re at a 40 percent risk for ovarian cancer, so we don’t want to take that chance. And so we do risk-reducing surgery.
Melanie: So if women have the BRCA gene, it puts them at a higher risk, and then it’s just a much more aggressive approach to prevention. Please tell us, Dr. Modesitt, why should women come to UVA for their ovarian cancer care?
Dr. Modesitt: Well, there’s been a lot of studies showing that you need to go to someone that’s an expert—so what’s called a high-volume center for surgery—for the option of getting clinical trials or intraperitoneal chemotherapy. These are things that we do every day. And so the benefit of coming to UVA is you see women or men positions who are top doctors for cancer and have access to all of the newest options.
Melanie: That’s really great information. Thank you so much, Dr. Susan Modesitt. You’re listening to UVA Health Systems Radio. For more information, you can go to uvahealth.com. This is Melanie Cole. Thanks so much for listening.